Clinical outcome following intraoperative computed tomography-assisted secondary orbital reconstruction

Abstract Background The aim of our study was to evaluate the additional benefit of intraoperative computed tomography (iCT), intraoperative computed tomography angiography (iCTA), and intraoperative computed tomography perfusion (iCTP) in the intraoperative detection of impending ischemia to established methods (indocyanine green videoangiography (ICGVA), microDoppler, intraoperative neuromonitoring (IONM)) for initiating timely therapeutic measures. Methods Patients with primary aneurysms of the anterior circulation between October 2016 and December 2019 were included. Data of iCT modalities compared to other techniques (ICGVA, microDoppler, IONM) was recorded with emphasis on resulting operative conclusions leading to inspection of clip position, repositioning, or immediate initiation of conservative treatment strategies. Additional variables analyzed included patient demographics, aneurysm-specific characteristics, and clinical outcome. Results Of 194 consecutive patients, 93 patients with 100 aneurysms received iCT imaging. While IONM and ICGVA were normal, an altered vessel patency in iCTA was detected in 5 (5.4%) and a mismatch in iCTP in 7 patients (7.5%). Repositioning was considered appropriate in 2 patients (2.2%), where immediate improvement in iCTP could be documented. In a further 5 cases (5.4%), intensified conservative therapy was immediately initiated treating the reduced CBP as clip repositioning was not considered causal. In terms of clinical outcome at last FU, mRS0 was achieved in 85 (91.4%) and mRS1-2 in 7 (7.5%) and remained mRS4 in one patient with SAH (1.1%). Conclusions Especially iCTP can reveal signs of impending ischemia in selected cases and enable the surgeon to promptly initiate therapeutic measures such as clip repositioning or intraoperative onset of maximum conservative treatment, while established tools might fail to detect those intraoperative pathologic changes.

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Review of the Clinical Applications of Intraoperative Computed Tomography in Skull Base and Sinonasal Surgery: Limited Value or Underutilized Technology?

Skull Base ◽

10.1055/s-2011-1274386 ◽

2011 ◽

Vol 21 (S 01) ◽

Author(s):

Ben Dixon ◽

Ian Witterick ◽

Jonathan Irish ◽

Michael Daly ◽

Harley Chan

Keyword(s):

Computed Tomography ◽

Skull Base ◽

Clinical Applications ◽

Intraoperative Computed Tomography

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Intraoperative computed tomography ‐guided transthoracic approach to giant calcified thoracic disc protrusion: Technical note

ANZ Journal of Surgery ◽

10.1111/ans.16943 ◽

2021 ◽

Author(s):

Jayshil A. Vyas ◽

James M. Gelder

Keyword(s):

Computed Tomography ◽

Technical Note ◽

Transthoracic Approach ◽

Disc Protrusion ◽

Intraoperative Computed Tomography ◽

Thoracic Disc

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Advantages of Modified Computed Tomography Severity Index of Acute Pancreatitis Over Other Scoring System

KYAMC Journal ◽

10.3329/kyamcj.v10i2.42790 ◽

2019 ◽

Vol 10 (2) ◽

pp. 110-113

Author(s):

Md Mofazzal Sharif ◽

Khaleda Parvin Rekha ◽

Umme Iffat Siddiqua ◽

Mst Monira Khatun ◽

AKM Enamul Haque ◽

...

Keyword(s):

Computed Tomography ◽

Acute Pancreatitis ◽

Clinical Outcome ◽

Severe Disease ◽

Severity Index ◽

Observer Variation ◽

Imaging Method ◽

Close Monitoring ◽

Early Assessment ◽

Prompt Treatment

Pancreatitis is one of most complex and clinically challenging of all abdominal disorders. USG and abdominal Computed Tomography (CT) are the most commonly used diagnostic imaging modalities for the evaluation of pancreas. Computed Tomography (CT) is highly accurate and sensitive than USG in both diagnosing as well as demonstrating the extent. Early assessment of the cause and severity of acute pancreatitis is of utmost importance for prompt treatment and close monitoring of patient with severe disease. CT is the imaging method of choice for assessing the extent of acute pancreatitis and for evaluating complications. CT severity index is used to assess prognostic correlation and clinical outcome of acute pancreatitis. Modified CT severity index makes the score easier to calculate and reduces the inter-observer variation. KYAMC Journal Vol. 10, No.-2, July 2019, Page 110-113

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Does Intraoperative Computed Tomography Scanning in Maxillofacial Trauma Surgery Affect the Revision Rate?

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2020.09.025 ◽

2020 ◽

Author(s):

Ahmed Alasraj ◽

Nasser Alasseri ◽

Essam Al-Moraissi

Keyword(s):

Computed Tomography ◽

Revision Rate ◽

Trauma Surgery ◽

Maxillofacial Trauma ◽

Intraoperative Computed Tomography ◽

Computed Tomography Scanning ◽

Tomography Scanning

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Value of Vascular and Non-Vascular Pattern on Computed Tomography Perfusion in Patients With Acute Isolated Aphasia

Stroke ◽

10.1161/strokeaha.120.028821 ◽

2020 ◽

Vol 51 (8) ◽

pp. 2480-2487

Author(s):

Salvatore Rudilosso ◽

Alejandro Rodríguez ◽

Sergio Amaro ◽

Víctor Obach ◽

Arturo Renú ◽

...

Keyword(s):

Computed Tomography ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Predictive Value ◽

Brain Perfusion ◽

Complete Recovery ◽

Vascular Perfusion ◽

Computed Tomography Perfusion ◽

Stroke Mimic ◽

Ischemic Attack

Background and Purpose: Acute onset aphasia may be due to stroke but also to other causes, which are commonly referred to as stroke mimics. We hypothesized that, in patients with acute isolated aphasia, distinct brain perfusion patterns are related to the cause and the clinical outcome. Herein, we analyzed the prognostic yield and the diagnostic usefulness of computed tomography perfusion (CTP) in patients with acute isolated aphasia. Methods: From a single-center registry, we selected a cohort of 154 patients presenting with acute isolated aphasia who had a whole-brain CTP study available. We collected the main clinical and radiological data. We categorized brain perfusion studies on CTP into vascular and nonvascular perfusion patterns and the cause of aphasia as ischemic stroke, transient ischemic attack, stroke mimic, and undetermined cause. The primary clinical outcome was the persistence of aphasia at discharge. We analyzed the sensitivity, specificity, positive and negative predictive values of perfusion patterns to predict complete clinical recovery and ischemic stroke on follow-up imaging. Results: The cause of aphasia was an ischemic stroke in 58 patients (38%), transient ischemic attack in 3 (2%), stroke mimic in 68 (44%), and undetermined in 25 (16%). CTP showed vascular and nonvascular perfusion pattern in 62 (40%) and 92 (60%) patients, respectively. Overall, complete recovery occurred in 116 patients (75%). A nonvascular perfusion pattern predicted complete recovery (sensitivity 75.9%, specificity 89.5%, positive predictive value 95.7%, and negative predictive value 54.8%), and a vascular perfusion pattern was highly predictive of ischemic stroke (sensitivity 94.8%, specificity 92.7%, positive predictive value 88.7%, and negative predictive value 96.7%). The 3 patients with ischemic stroke without a vascular perfusion pattern fully recovered at discharge. Conclusions: CTP has prognostic value in the workup of patients with acute isolated aphasia. A nonvascular pattern is associated with higher odds of full recovery and may prompt the search for alternative causes of the symptoms.

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Evaluation of Tarsal Navicular Stress Fracture Fixation Using Intraoperative O-arm Computed Tomography

Foot & Ankle Specialist ◽

10.1177/1938640014532130 ◽

2014 ◽

Vol 7 (6) ◽

pp. 515-521 ◽

Cited By ~ 4

Author(s):

Andrew R. Hsu ◽

Simon Lee

Keyword(s):

Computed Tomography ◽

Stress Fracture ◽

Guide Wire ◽

Weight Bearing ◽

Fracture Site ◽

Stress Fractures ◽

Functional Impairments ◽

Intraoperative Ct ◽

Intraoperative Computed Tomography ◽

Anatomic Reduction

Stress fractures of the tarsal navicular are high-risk injuries that can result in displacement, avascular necrosis, malunion, and nonunion. Delayed diagnosis and improper treatment can lead to long-term functional impairments and poor clinical outcomes. Increased shear stress and decreased vascularity in the central third of the navicular can complicate bony healing with often unpredictable return times to activity using conservative management in a non-weight-bearing cast. There recently has been increasing debate regarding the effectiveness of treatment options with a trend toward surgical management to anatomically reduce and stabilize navicular stress fractures in athletes. However, anatomic reduction and fixation of the navicular can be difficult despite direct visualization and intraoperative fluoroscopy. We report a case of a chronic navicular stress fracture in a high-level teenage athlete treated with open reduction internal fixation (ORIF) and calcaneus autograft using intraoperative computed tomography (CT) (O-arm®, Medtronic, Minneapolis, MN) for real-time evaluation of fracture reduction and fixation. Intraoperative CT was fast, reliable, and allowed for confirmation of guide wire orientation, alignment, and length across the fracture site. Anatomic fixation of navicular stress fractures can be challenging, and it is important for surgeons to be aware of the potential advantages of using intraoperative CT when treating these injuries. Levels of Evidence: Therapeutic, Level IV: Case Report

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